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Diagnostic and Therapeutic Approach to Kidney Patient

Diagnostic and Therapeutic Approach to Kidney Patient. S. Ossareh- M.D. HKC-IUMS. Nephrotic Syndrome/GN. Lab: CBC, ESR BUN, Cr, Na, K (daily?!!) PPD VDRL Lipid profile FBS? Uric acid Protein, Albumin HBsAg , HCV Ab , HIV Ab Immunologic: ANA, ANCA, C3, C4, CH50,antiGBM Ab ?

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Diagnostic and Therapeutic Approach to Kidney Patient

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  1. Diagnostic and Therapeutic Approach to Kidney Patient S. Ossareh- M.D. HKC-IUMS

  2. Nephrotic Syndrome/GN • Lab: • CBC, ESR • BUN, Cr, Na, K (daily?!!) • PPD • VDRL • Lipid profile • FBS? • Uric acid • Protein, Albumin • HBsAg, HCV Ab, HIV Ab • Immunologic: ANA, ANCA, C3, C4, CH50,antiGBM Ab? • Urinalysis, Urine sediment • 24 hour urine collection for protein, creatinine • PTT, PT • Sonography • KUB

  3. ESRD patients

  4. Paraclinic • LAB: • CBC,ESR • BUN, Cr (daily?!!) • Na, K (daily?!!) • Ca, P, ALP,PTH • Lipid profile • Fe, Ferritin,TIBC • Retic, Coombs,S/E, • HBsAg, HCV Ab, HIV Ab • Sonography • X-Rays as needed

  5. Erythropoetin(Eprex, PD Poetin, Epocin) • Hb/Hct goal: • 11/33% for women • 12/36% for men & post-menopausal women • Start Eprex with 50-100 unit/kg/wk • Hb>13 → Reduce Eprex dose • Hb> 13.5 → Stop Eprex for 1 month

  6. Iron supplement(Venofer, ferrous sulfate) • Iron status goal: • Ferritin> 200 and Fe/TIBC> 20% • Give IV Venofer 300 mg/wk till you reach the goal • Then reduce Venofer dose to 100 mg/wk to keep iron profile within the expected range • If ferritin > 500 → reduce Venofer dose • If ferritin > 800 &/or Fe/TIBC> 50% → Stop Venofer

  7. Calcium supplement(Calcium Carbonate, Ca-D) • Goal: Keep Ca between 8.4 to 9.5 mg/dl • Maximum maintenance dose of Ca: 2 grams of elemental Calcium • Keep P between 4-5.5 mg/dl with 1.5-2 grams of elemental Calcium Carbonate • P < 4 mg/dl → CaCO3 between meals

  8. Calcium supplement(Calcium Carbonate, Ca-D) • P: 4-5.5 mg/dl → CaCO3 3 tabs/day (with meals) • P:5.5-7 mg/dl → CaCO3 4-6 tabs/day for a limited period (with meals) • P > 7 mg/dl or Ca  P >55 → Stop Calcium and use Al(OH)3 for a limited period (30 ml tid for 3-4 weeks)

  9. Rocaltrol (Calcitriol) • If P < 5.5 mg/dl, and Ca < 9.5 and CaP <55 start Rocaltrol to keep PTH level between 150-300 pg/ml • PTH: 300-600 → 2-6 pearls/qod • PTH: 600-1000 → 4-16 pearls/qod • PTH> 1000 → 12-28 pearls/qod

  10. Vitamin Supplements • Folic Acid: 5 mg Bid • B-Complex: 1 tab/ day • B6: 1 tab/day

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